| Abstract: | At doses greater than 125–150 mg daily, tricyclic antidepressants (TCAs) have been shown to be effective in patients with depressive illness. There is nevertheless, a pronounced tendency in general practice to prescribe antidepressants at half the dose likely to be prescribed for the same patient by a psychiatrist. The principal motivation for subtherapeutic dosing in primary care is to avoid the side-effects of TCAs which are likely to deter patients from complying with treatment. The misconception also prevails among some general practitioners that patients seen in general practice have less severe disorders and therefore require a reduced dose. Yet there is no clinical evidence to show that at doses of 75 mg daily or lower, TCAs are effective in the treatment of depressive illness. It is against all the principles of therapeutics to prescribe a given drug at a dosage below its therapeutic level. A more rational strategy would be to select a better tolerated antidepressant at the outset, such as one of the second generation antidepressants. |
